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Strong Medicine Interview with Lyle Micheli, 14 August 2014
JOAN ILACQUA: [00:00] Good morning, this is Joan Ilacqua, and
today is August 14th, 2014. I’m here with Dr. Lyle Micheli,
at Boston Children’s Hospital, and we’re going to record an
interview, as part of the Strong Medicine oral history
project. Dr. Micheli, do I have your permission to record
the interview?
LYLE MICHELI: Yes.
ILACQUA: Excellent. So, my first question is background on
you. Could you tell me a bit about your background, how
you ended up at Children’s, and what you do here today?
MICHELI: Mm-hmm. I come from Illinois -- north-central
Illinois. My family were coal miners. Got a scholarship
to Harvard College, National Merit Scholarship. And then I
got into Harvard Medical School, and then I went through
orthopedic training. After my orthopedic training, I
served in the Military, in the Air Force. At the end of
the Vietnam War, I came back to Harvard, to join the
faculty.
ILACQUA: Excellent. And so, your title here at Children’s
Hospital, what is that exactly?
MICHELI: I’m a Director of the Division of Sports Medicine.
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ILACQUA: OK. And so, on a typical day, as Director of the
Division of Sports Medicine, what would that look like for
you?
MICHELI: I perform surgeries three and a half days a week, and
then I -- on those days, I sometimes also will see
patients, and I see patients in clinics, a clinic setting.
The other day and a half, and every other Saturday, I see
patients. And so that’s a heavy clinical load. We also
are involved -- we have a fellowship training program here
in sports medicine, orthopedic and primary care sports
medicine. And we also do research.
ILACQUA: Excellent. And what’s your relationship with the
Boston Marathon? Do you usually work on that day?
MICHELI: I’ve worked -- I’ve been working the finish line of
the Boston Marathon since 1975. And I believe in the early
’80s, I became the director, coordinator of the finish line
medical coverage.
ILACQUA: Excellent. And so, on a typical Marathon Monday, what
would you be doing that day, as director?
MICHELI: Well, initially, in the earlier days, I used to be
able to do an operation or two, and then I’d go down to the
marathon. And that was when the race began at 12. It now
begins earlier, at 10. But generally, get up in the
morning, come to the hospital, make sure there’s no issues
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here, and then take a subway into the marathon finish line.
And then we have a volunteers meeting, first thing in the
morning. Talk over any issues, such as weather, expected
field, expected range of injuries, particularly heel
injuries. And then we would go to the finish line.
At the finish line, I usually have five or six physicians,
who are coming from our training program. We use this as
part of our training for our fellows. And then we also
have, in recent years, physician assistants working with us
at the finish line. And then the contingent at the finish
line includes athletic trainers, and athletic training
students.
ILACQUA: Excellent. And so, turning to the Boston Marathon,
2013, could you describe how that day began for you?
MICHELI: Yeah. We went down to the finish line, and we had our
medical volunteers’ meeting. The conditions were fairly
favorable, as far as temperature and humidity, and so
forth. So we were reassured in that regard. And then, we
went to the finish line at about 10:00, because some of the
early wheelchair finishers would be coming in shortly after
that. And our job is to do on-site triage. There’s the
finish line medical coverage. There’s a chute, C-H-U-T-E
medical coverage, where we have athletic trainers in chute,
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observing anyone who might be staggering or falling down.
And then, of course, we have the large medical contingent
in the medical tent -- Tent A. And we have a second tent,
Tent B, which was about 300 yards away. But in Tent A, Dr.
Pierre D'hemecourt, who’s one of my colleagues here at
Children’s, is a medical -- in charge of medical Tent A,
and includes the coordination of the entire marathon.
And so, in general, people finish the marathon, go through
the chutes, go and get their medal, and walk down, and get
water and so forth. Anyone who’s having problems is
triaged in a very efficient manner, nowadays, into the
tent, to be assessed and treated.
ILACQUA: Excellent. And so, on that day, as the day went on,
were things sort of typically happening?
MICHELI: Oh, things were idea. It was ideal weather. We
weren’t having much problems. We have our usual people
finishing in about three hours, who are sometimes having
problems, and collapsing, and so on. We often -- it’s
amazing how people will come right to the finish line, and
then collapse. They got that far. Sometimes, we have
people collapsing out along the course, in the front of the
course.
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But things were [05:00] going very smoothly. And we were
all acknowledging how smoothly it went. In retrospect,
they did have bomb dogs go through the area, at about 10:00
a.m., 10:30 a.m. And that was the only time I saw them.
But they went through before the event, just checking out
the possibility of explosions.
ILACQUA: Mm-hmm. And so, as the afternoon went on, where were
you when things happened? When...
MICHELI: I was standing on the finish line, which is my
position, just triaging, watching people. And according to
the photos that we’ve seen, from the video footage, and so
forth, I started to walk back, away from the finish line,
with a young woman, who was having some type of an arm
problem. I was looking at her arm. And then I sort of had
my back to the first explosion. And it was -- I was
probably about 30 yards away from it. But turned around,
and I thought it was some kind of a prank. I thought some
kind of -- some damn college kids were setting off a smoke
bomb, or something like that. And then, I turned back to
this young woman, and then, the smoke got to me, and I
smelled gunpowder. And I know gunpowder from the Military.
I says, “Gunpowder? What? What would something be having
gunpowder?” And then, because then the second bomb went
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off, about 10 seconds later. And then it was clear that
there was viol-- a viol-- it was a violent activity.
And so, some of us ran toward the site of the first bomb,
and started taking down the barriers. I think they -- if
we were -- I could say that, in -- pretty clearly, that no
medical volunteers, no public safety volunteers were
injured. There was like a snow fencing. There was like
construction scaffolding between the running area, the
street, and the crowd, the observers. And then there was a
snow fence up, right here. And I think the snow fence is
what protected us from shrapnel. I think that there would
have been more injuries of people right on the finish line,
if that hadn’t been the case, but I saw no one injured at
the finish line. There’s a well-known picture of an old
elderly gentleman, a runner, who falls down at the finish
line. He didn’t get hit by the shrapnel, he was just
tired. He was just the usual tired runner, who collapsed.
But one young fellow went up to the stage -- up to the
barriers there, and jumped over the top, and pulled down
the snow fence from the -- toward the inside. The bomb had
gone off right in front of the marathon -- the first bomb
had gone off right in front of the marathon sporting goods
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store. The windows were all blown out. And there were
people lying around in front of the store. I saw one
woman, lying face-down, in the doorway, entrance of the
marathon store. It wasn’t clear whether she was outside or
inside when it happened. I think she was blown -- or fell
down that way. So I went up to her. Because she was the
one the obviously needed the most initial assistance.
There was a runner assisting me, and he and I talked
afterwards. He was a Military officer, a student at the
Harvard Business School. And so he and I sort of pulled
her inside the store, and then turned her over. She was
bleeding from the back of her popliteal space -- back of
her knee. And, but still was pretty much with it. And she
-- and so, we went to the racks of the running store, and
got a running jacket off the racks, and put it on her upper
thigh. And then got a clothes hanger from the racks, and
then -- because we had no equipment, see? Those of us on
the finish line -- we now do, but at that time, we had no
tourniquets, not even dressings, because any kind of
dressings, that would take place, it would usually be
taking place down in the medical tent, if we triaged
someone down there. So we had to improvise with such
things.
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We made a tourniquet out of the running jacket, and a
clothes hanger. And then I -- I had gloves on. I examined
the back of her knee, just wanted to make sure there was no
pulsing vessels, or anything like that. And I remember
feeling an irregularly-shaped -- felt like a piece of metal
in there, embedded in the back of her bone -- in the back
of her femur. And I thought, what is this? You know? And
we only -- we learned later, of course, that there was
shrapnel, that it -- I thought of a bomb as just going
“boom,” like a firecracker, and maybe knocking people down.
But of course, they filled that bomb with various pieces of
metal. And it was a -- I felt it -- probably was feeling
part of the pressure cooker, on the back of her leg.
So, we had turned her over. Got the tourniquet on her, and
then the EMTs started to arrive, because they -- the other
volunteers had pulled down the remainders of the barrier.
They could get stretchers into that area, where the
casualties were. And so, about four of us lifted her up
onto the -- onto a wheeled stretcher. And they then took
her out.
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I went and assisted another woman, who was lying down in
front of the [10:00] stair area of the Marathon Sports.
And then we got her out, and then someone came running up,
and said, “We’re concerned that there may be more bombs
around here, so let’s clear this area.” So we cleared out
of the Marathon Sport area. And then I went down into the
tent, and there were various casualties there. The EMTs
had set up a triage system. They had little plastic
markers, one, two, or -- number one, two, or three, for
one, immediate transport; two, secondary; and then three,
less important.
And there was one young woman there, who was lying on her
back. I think, in retrospect, she was the daughter of the
woman who had had the bad injuries to her legs. But we
dressed her up, put dressings on her, elevated her leg.
Her motor functions seemed to be fine. She had a big
gashing-type cut, along the inside of her leg, down to the
ankle, into the knee, and I just packed that with
dressings, put tape around it. And then we lifted her up
out of her stretcher. She was way near the front of the
tent. And we carried her down to the back of the tent,
where the ambulances were going out, and where the triage
system was being done.
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And then, a couple of more people, I went to different
stretchers, and the personnel in there were -- obviously,
they’d been set up to deal with heat problems, or starting
IVs, and so forth. But unfortunately, of course, we were
so close to the casualties. And we had medical personnel
so close. So most people got tourniqueted -- those who had
major extremity injuries got tourniqueted with belts.
People would take their belts off.
And then -- this is about a half hour after the bomb went
off, and then someone -- some public safety officer came in
and said, “We’re clearing the tent. We’re concerned there
might be a bomb in the tent.” So we got everybody out of
Tent A. We got them down, into the ambulances very
quickly, and fortuitously, we had six or seven teaching
hospitals nearby. The EMTs were there because of the
marathon. They had many ambulances there. And so they
were instantly able to transport people.
So we cleared Tent A, and then we went down to Tent B. And
that was still open. And the runners by that time had been
diverted away from the finish line, down into the Boston
Common. So we had a couple of people go down to the Boston
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Common, and tell people that if they needed it, we would
see them in Tent B. And there wasn’t that many people that
needed help. Again, the running conditions were ideal. So
the actual runner runners -- and these are later runners.
These are runners who have been running about five hours,
because the marathon started at 10:00. So by and large,
they were in pretty good shape. So there weren’t many
people in need of that.
So we got down to Tent B, I think probably about an hour
later. And then, there was -- public transportation had
been stopped. So I walked back to Children’s. And -- from
the finish line. And then went into the Emergency Room, to
see if there was any needs there. And the kids that come
into Children’s were already up in the operating rooms. So
they didn’t need me there, so I walked home.
ILACQUA: So you had mentioned that you had served at the tail
end of Vietnam. Had you ever dealt with casualties like
this before?
MICHELI: Yes, but not in this many numbers at one -- one period
of time. We were -- I was stationed in Washington, DC, at
Andrews Air Force Base, and we would get the kids back, oh,
two or three days a week, we’d get three or four of them
coming in on the Air Evac (inaudible), with lower extremity
12
injuries. But no. And we had drills in this, of course.
We had drills in mass casualty issues, and with how to
triage and all that kind of stuff, and so forth. While in
the Military. Because Andrews is a major training base
there. But that’s -- not so many at one time.
ILACQUA: Hm. And actually, in your capacity as director at the
Marathon finish line, had you drilled for an event like
this before? Had you trained for, if there was a large
emergency at the finish line?
MICHELI: Oh, not really. No, we were prepared -- we were
always -- we were prepared for the -- to estimate the
casualties, the running casualties, based on sort of
temperature and wet-bulb temperature. It’s a direct,
linear line. The hotter and more humid it is, the more
running -- or exhausted runners we see. And runners
collapse from a variety of things; hypervolemia; poor fluid
intake; thermal, hypo- or hyperthermia, and so forth.
Those are the things we were prepared for.
And we -- so, as I said, we didn’t have much in the way of
dressings. We had one little area of the medical tent is
[15:00] reserved for musculoskeletal injury, like
abrasions, and stuff like that. If someone has fell on the
course, this kind of thing. But between the EMTs with
13
their kits, and sort of using them, we sort of made do, and
I think it was extremely fortuitous that the bombs were so
close to the medical area, because I think if the bombs
were three or four blocks away from where they went off,
we’d have had many more fatalities. These people, of
course, probably 10 or 15 of them lost extremities, you
know, their -- one -- some -- three or four people had both
legs blown off. And -- but there was immediate application
of tourniquets -- good old-fashioned tourniquets, just like
in a Military situation, which is what we trained for, in
the Military. We all carry tourniquets. But -- so we had
to make do, and make up our own tourniquets.
ILACQUA: And so, you had mentioned that you walked back to
Children’s after sort of closing up shop, down that finish
line.
MICHELI: Yup.
ILACQUA: And the kids that were there were already in surgery.
MICHELI: They were already up, yeah.
ILACQUA: Was there anything else going on at Children’s?
Were...?
MICHELI: No, no, I think the people had mobilized pretty
quickly. I mean, it is sort of amazing to see how quickly
the timeline was. The -- I’m told that the first patient
at the Beth Israel, first marathon patient was in the
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operating rooms 60 minutes after the bomb went off. Which
means that they were retrieved at the scene, often brought
into the medical tent with wheelchairs, which is what we
used for the fallen runners, but we just used the
wheelchairs as transport for them. And the athletic
training students were the ones pushing the wheelchairs.
They just went into that mode.
And then they’d go into that medical tent, get initial
dressings, perhaps, or makeshift tourniquets, or bandages,
and so forth. Out the far end -- in the front end of the
medical tent, out the far end of the medical tent, into an
ambulance, down the street, down to the Emergency Room of
the BI, triaged there, up the elevators to the operating
room, in the operating room, in 60 minutes.
ILACQUA: Hm.
MICHELI: Yup.
ILACQUA: And so, you mentioned that you had gone home after you
checked in at Children’s. could you describe how the rest
of the week started to play out for you?
MICHELI: Yeah, I had patients the next day. I had surgeries
and patients the next day. So I went in and did my
surgeries, and then saw my patients. And -- of course,
there was a lot of excitement, and issues about the
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marathon, and so forth. And about a week later, we had --
from Children’s had probably about 20 -- 15 or 20
volunteers from our Sports Medicine group. We
traditionally cover the finish line, and also, our fellows
are in the -- some of our fellows are in the tents, and
some are at the finish line. And so, some people were out
of work, didn’t come back to work for a while. A week or
two, sometimes.
And then the Children’s has a physician support mechanism,
through the Department of Psychiatry. And so, about a week
after the Marathon, we had a meeting of the people who were
there at the finish line, and talked over issues, and so
forth, and... But again, there was a variable around of
post-traumatic issues. I don’t think I had much of any.
But there were people who had issues, and were out of work
for a while, or on limited work duty for up to a few
months, sometimes.
But I think that -- and this is where I’m sort of puzzled
by the post-traumatic stress syndrome issue, because I
could see having post-traumatic stress syndrome, if you
were -- if you had your leg blown off. But for a medical
personnel, who are trained in this type of thing -- maybe
16
to a greater or a lesser extent -- I think it -- a little
harder for me to understand post-traumatic stress syndrome
in that setting. I’d be interested someday to look at what
the Military has found, as far as medical personnel, in
that setting. I think that the popular version is MASH.
You don’t see much evidence of post-traumatic stress
syndrome in those scenarios, in their sequels, and so
forth. But perhaps there is an incidence of it in medical
personnel, in that situation.
But I think that -- again, a combat veteran, who’s in
combat for three to five days at a time, I [20:00] could
understand post-traumatic stress syndrome. And we have --
I have a family history of that. But I’m a little
surprised sometimes at some medical personnel, for
instance, who were in Tent B, which was about a quarter of
a mile away from anything, and didn’t see any, really, any
casualties. No casualties went to Tent B, as it turned
out. But people in Tent B had post-traumatic stress
syndrome.
ILACQUA: Hm.
MICHELI: Hard to under-- hard for me to understand that. Yup.
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ILACQUA: Yeah, that’s interesting. I didn’t -- I haven’t heard
of that. So it sounds like you got back to business pretty
quickly --
MICHELI: Yup.
ILACQUA: -- after. Could you describe, you know, was there
extra security at Children’s? Was there a media presence
going on, or...?
MICHELI: Oh, yeah. I think that there was -- across, the
entire city, they beefed up security, and there was extra
security. There certainly was more security the following
year, 2014, when -- the Marathon. And I must admit, I was
a little apprehensive about that day. I was very happy
when it was over, (laughs) because I thought it would be a
perfect target, to really show those Americans who was
boss, you know? To hit it again. Make sure that our
security measures...
And, needless to say, it’s extremely difficult to provide
tight security for a marathon. It’s not a stadium event.
It’s not like a baseball game, or a football game, where
you have a confined site. But to really do security at the
marathon, would be, I think very difficult, in any
circumstance. They had many more dogs there, in 2014.
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More security personnel, and so forth. And it went well,
of course; we did not have any episodes, or instances.
But I think that, going out, the Boston Marathon’s gotten
so much play, as a symbol of strength, and resistance, and
so forth. I think it will remain a target.
ILACQUA: Hm.
MICHELI: Yup.
ILACQUA: In the -- you mentioned the new, or heightened sense
of security. Did you do training in emergency management,
down at the tent? Or did you end up with tourniquets this
year?
MICHELI: Yes, we have didantic [sic] lectures for the
volunteers at -- medical volunteers. And there was --
there was much more talk about this being perceived as a
mass casualty event. Of course, in some ways, a planned
one. But to use that as a training device for handling
mass casualty episodes, you know, in an urban area, or
whatever. Yeah. And so, I think that there’s much more
awareness now of that. I got a couple tourniquets I
carried in my pocket, in 2014.
ILACQUA: Hm.
MICHELI: (laughs) Military tourniquets. Yeah, yeah, yup.
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ILACQUA: So, I wanted to go back for a second, because I
skipped a question that I should have asked. While
everything was going down, were you in contact with family,
or the hospital, or anyone else, while you were at the
medical tent? Were you aware of anything else going on in
the city?
MICHELI: No. I had -- we had no contact. For one thing, they
-- I think the jammed the cell phones in the area. But I
was too busy doing stuff, (laughs) to communicate. Yeah,
yeah, yup.
ILACQUA: OK. And, let’s see. So we, more or less, have gone
over most of my questions. But as the year unfolded from
the 2013 Boston Marathon to the 2014, do you think it had a
lasting impression on your job, or your profession, or your
personal life, in any ways?
MICHELI: Well, I think that I’m going to continue to volunteer
at the Marathon. And so, to that extent, I think that
we’re aware of it, as a potential issue. I think that it’s
a new chapter now, and I think across the world, in running
marathons, you know, and it -- and it’s -- and the
organizing, and setting up medical cover for it, and
security coverage for it. So this bombing has been a new
chapter in this type of sporting activity. But I think
that, with current world of events, as they’re going down,
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I think that makes us all realize, it can come right in
your own back yard. Yeah. And the -- the violence, and
the fanaticism that’s going on in certain parts of the
world, I think can spill over to here.
ILACQUA: Hm.
MICHELI: Yup.
ILACQUA: Yeah. And so, finally, are there any other thoughts
or stories that you’d like to share with us, today?
MICHELI: [25:00] I think that -- as I said, maybe mentioned
earlier, I would think, really think the unsung heroes of
that day, that -- were the -- these young athletic training
students, who -- they thought they were there to push
wheelchairs for marathoners who’d collapsed, and we’d
popped into the wheelchair. But they jumped into action
pretty quickly. And there is that one famous picture of
the gentleman spectator, who had both legs traumatically
amputated, and there’s a man running along with a cowboy
hat next to him. But no one has ever -- no mention is ever
made of the young woman, the young athletic-training woman,
who’s pushing the wheelchair, who truly is the unsung hero,
because she’s the one who did something. (laughs) She got
the guy in there, and down, and probably was instrumental
in helping save his life, and -- but the -- I think with --
she wasn’t wearing a cowboy hat. (laughs)
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ILACQUA: All right. Well, thank you for speaking with me
today.
MICHELI: You bet.
ILACQUA: All right.
MICHELI: Good. [26:06]
END OF AUDIO FILE